Hemochromatosis type 1

disease
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Also known as C282Y/C282Y hemochromatosisclassic hemochromatosishemochromatosishemochromatosis, type 1HFE-associated hereditary hemochromatosisHFE-related hemochromatosisHFE1symptomatic form of hemochromatosis type 1

Summary

Hemochromatosis type 1 (MONDO:0021001) is a disease caused by HFE (GenCC Definitive), with 7 cohort genes (2 GWAS associations across 1 studies) and 24 clinical trials. The dominant Reactome pathway is Transferrin endocytosis and recycling (3 cohort genes). Top therapeutic interventions include deferoxamine, deferiprone, and deferasirox.

At a glance

  • Causal gene: HFE (GenCC Definitive)
  • Cohort genes: 7
  • GWAS associations: 2
  • ClinVar variants: 83
  • Clinical trials: 24

Clinical features

No curated clinical features (Orphanet) for this disease.

Identifiers

Disease identifiers

FieldValue
Canonical namehemochromatosis type 1
Mondo IDMONDO:0021001
EFOEFO:0006513
OMIM235200
Orphanet139498
DOIDDOID:0111029
NCITC84764
UMLSC3469186
MedGen854011
Is cancer (heuristic)no

Also known as: C282Y/C282Y hemochromatosis · classic hemochromatosis · hemochromatosis · hemochromatosis type 1 · hemochromatosis, type 1 · HFE-associated hereditary hemochromatosis · HFE-related hemochromatosis · HFE1 · symptomatic form of hemochromatosis type 1

Data availability: 83 ClinVar variants · 2 GWAS associations (1 study) · 6 GenCC gene-disease records · 25 cell lines.

Disease family

Classification path: disease › human disease › disease by developmental or physiological process › metabolic diseasemineral metabolism diseaseiron metabolism diseasehemosiderosishereditary hemochromatosishemochromatosis type 1

Related subtypes (7): neonatal hemochromatosis, African iron overload, hemochromatosis type 3, hemochromatosis type 4, hemochromatosis type 5, hemochromatosis type 2, digenic hemochromatosis

Genetics & variants

GWAS landscape

2 GWAS associations across 1 studies. Top hits map to 1 distinct genes (as reported by GWAS).

Top associations by p-value

rsIDp-valueGeneRisk alleleOdds ratio
rs38116472e-20TF?0.4

Top studies (by case count)

StudyLead authorYearCasesControlsTitle
GCST002660de Tayrac M20144740Genome-wide association study identifies TF as a significant modifier gene of iron metabolism in HFE hemochromatosis.

Variant details and genetic-evidence tiers

Tier distribution (top 50 variants)

TierVariants
Tier 1: coding0
Tier 2: splice/UTR0
Tier 3: regulatory0
Tier 4: intronic/intergenic1

MAF distribution

BucketVariants
common (>=0.05)1
low_freq (0.01-0.05)0
rare (<0.01)0
unknown0

Functional consequences

ConsequenceCount
intron_variant1

Top variants

rsIDChrPosAllelesMAFConsequenceGenep-valueTier
rs38116473133765185G>A,C0.05intron_variantTF2e-20Tier 4: intronic/intergenic

ClinVar germline variants

83 retrieved; paginated sample, class counts are floors:

45 uncertain significance, 10 conflicting classifications of pathogenicity, 8 pathogenic/likely pathogenic, 6 pathogenic, 6 likely pathogenic, 3 benign/likely benign, 2 benign, 1 conflicting classifications of pathogenicity; other, 1 not provided, 1 conflicting classifications of pathogenicity; other; risk factor

ClinVarVariant (HGVS)GeneClassificationReview
1065637NM_000410.4(HFE):c.1006+1G>AHFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1071037NM_000410.4(HFE):c.1022_1034del (p.His341fs)HFEPathogeniccriteria provided, multiple submitters, no conflicts
1073981NM_000410.4(HFE):c.211C>T (p.Arg71Ter)HFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
18NM_000410.4(HFE):c.989G>T (p.Arg330Met)HFEPathogenicno assertion criteria provided
19NM_000410.4(HFE):c.848A>C (p.Gln283Pro)HFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
2152189NM_000410.4(HFE):c.548T>C (p.Leu183Pro)HFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
3075867NM_000410.4(HFE):c.616+1G>AHFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
3384778NM_000410.4(HFE):c.166C>T (p.Gln56Ter)HFEPathogeniccriteria provided, single submitter
407073NM_000410.4(HFE):c.892G>T (p.Glu298Ter)HFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
407079NM_000410.4(HFE):c.546_547del (p.Leu183fs)HFEPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
88946NM_000410.4(HFE):c.502G>T (p.Glu168Ter)HFEPathogeniccriteria provided, single submitter
2365NM_213653.4(HJV):c.959G>T (p.Gly320Val)HJVPathogeniccriteria provided, multiple submitters, no conflicts
2371NM_213653.4(HJV):c.963C>A (p.Cys321Ter)HJVPathogenicno assertion criteria provided
802342NM_003227.4(TFR2):c.2101C>T (p.Arg701Ter)LOC113687175Pathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1185560NM_000410.4(HFE):c.262A>T (p.Ser88Cys)HFELikely pathogenicno assertion criteria provided
1217279NM_000410.4(HFE):c.688TAC[1] (p.Tyr231del)HFELikely pathogeniccriteria provided, single submitter
2575054NM_000410.4(HFE):c.340+1G>AHFELikely pathogenicno assertion criteria provided
3593440NM_000410.4(HFE):c.106_109del (p.Gly36fs)HFELikely pathogeniccriteria provided, single submitter
3593441NM_000410.4(HFE):c.340+1G>THFELikely pathogeniccriteria provided, single submitter
633265NM_000410.4(HFE):c.77-2_78delinsTGGAGTCHFELikely pathogeniccriteria provided, single submitter
10NM_000410.4(HFE):c.187C>G (p.His63Asp)HFEConflicting classifications of pathogenicity; othercriteria provided, conflicting classifications
11NM_000410.4(HFE):c.193A>T (p.Ser65Cys)HFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
237780NM_000410.4(HFE):c.1026C>T (p.Tyr342=)HFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
356194NM_000410.4(HFE):c.68G>A (p.Arg23His)HFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
356196NM_000410.4(HFE):c.829G>A (p.Glu277Lys)HFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
356208NM_000410.4(HFE):c.*988G>AHFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
356209NM_000410.4(HFE):c.*991C>THFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
414267NM_000410.4(HFE):c.21G>A (p.Pro7=)HFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
461195NM_000410.4(HFE):c.884T>C (p.Val295Ala)HFEConflicting classifications of pathogenicitycriteria provided, conflicting classifications
9NM_000410.4(HFE):c.845G>A (p.Cys282Tyr)HFEConflicting classifications of pathogenicity; other; risk factorcriteria provided, conflicting classifications

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 7 · Orphanet: 14 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

GenCC gene–disease validity (cohort genes)

the Disease column is the GenCC-asserted condition — a cohort gene’s strongest validity may be for a related predisposition syndrome.

GeneClassificationInheritanceDiseaseRecords
HFEDefinitiveAutosomal recessivehemochromatosis type 17

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
HFEOrphanet:443057Sporadic porphyria cutanea tarda
HFEOrphanet:443062Familial porphyria cutanea tarda
HFEOrphanet:465508Symptomatic form of HFE-related hemochromatosis
HFEOrphanet:586Cystic fibrosis
HFEOrphanet:648581Digenic hemochromatosis
SLC40A1Orphanet:647834SLC40A1-related hemochromatosis
SLC40A1Orphanet:648562Ferroportin disease
TFOrphanet:1195Congenital atransferrinemia
TFR2Orphanet:225123TFR2-related hemochromatosis
TFR2Orphanet:648581Digenic hemochromatosis
HAMPOrphanet:648581Digenic hemochromatosis
HAMPOrphanet:79230HJV or HAMP-related hemochromatosis
HJVOrphanet:648581Digenic hemochromatosis
HJVOrphanet:79230HJV or HAMP-related hemochromatosis

Cohort genes → proteins

7 cohort genes, 6 distinct canonical proteins.

Evidence partition

SubsetGenes
gwas_only1
multi_evidence6

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
HFEHGNC:4886ENSG00000010704Q30201Hereditary hemochromatosis proteingencc,clinvar
SLC40A1HGNC:10909ENSG00000138449Q9NP59Ferroportinclinvar
TFHGNC:11740ENSG00000091513P02787Serotransferringwas
TFR2HGNC:11762ENSG00000106327Q9UP52Transferrin receptor protein 2clinvar
HAMPHGNC:15598ENSG00000105697P81172Hepcidinclinvar
HJVHGNC:4887ENSG00000168509Q6ZVN8Hemojuvelinclinvar
HFE-AS1HGNC:55168HFE antisense RNA 1clinvar

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
HFEHereditary hemochromatosis proteinBinds to transferrin receptor (TFR) and reduces its affinity for iron-loaded transferrin.
SLC40A1FerroportinTransports Fe(2+) from the inside of a cell to the outside of the cell, playing a key role for maintaining systemic iron homeostasis.
TFSerotransferrinTransferrins are iron binding transport proteins which can bind two Fe(3+) ions in association with the binding of an anion, usually bicarbonate.
TFR2Transferrin receptor protein 2Mediates cellular uptake of transferrin-bound iron in a non-iron dependent manner.
HAMPHepcidinLiver-produced hormone that constitutes the main circulating regulator of iron absorption and distribution across tissues.
HJVHemojuvelinActs as a bone morphogenetic protein (BMP) coreceptor.

Protein-family classification

Druggable: 3 · Difficult: 0 · Unknown: 4 · Druggable fraction: 0.43

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Transporter111.1×0.289
Protease15.2×0.289
Antibody/Immunoglobulin14.2×0.289
Other/Unknown41.0×0.626

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
HFEAntibody/ImmunoglobulinyesMHC_I_a_a1/a2, Ig/MHC_CS, Ig_C1-set
SLC40A1TransporteryesFerroportin-1, MFS_trans_sf
TFOther/UnknownnoTransferrin-like_dom, Transferrin, Transferrin_Fe_BS
TFR2ProteaseyesPA_domain, Peptidase_M28, TFR-like_dimer_dom_sf
HAMPOther/UnknownnoHepcidin
HJVOther/UnknownnoRGM_C, RGM_N, RGM
HFE-AS1Other/Unknownno

Expression context

Cohort genes with no expression data: 1.

6 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)6
unknown1

Top tissues across cohort

TissueCohort genes
right lobe of liver2
olfactory bulb1
stromal cell of endometrium1
type B pancreatic cell1
epithelial cell of pancreas1
oviduct epithelium1
pancreatic ductal cell1
corpus callosum1
inferior vagus X ganglion1
medulla oblongata1
liver1
vena cava1
cardiac atrium1
right atrium auricular region1
gastrocnemius1
hindlimb stylopod muscle1
skeletal muscle tissue of rectus abdominis1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
HFE238ubiquitousmarkertype B pancreatic cell, olfactory bulb, stromal cell of endometrium
SLC40A1260ubiquitousmarkerpancreatic ductal cell, epithelial cell of pancreas, oviduct epithelium
TF249broadmarkerinferior vagus X ganglion, medulla oblongata, corpus callosum
TFR2188tissue_specificmarkerright lobe of liver, liver, vena cava
HAMP223broadmarkerright lobe of liver, right atrium auricular region, cardiac atrium
HJV147tissue_specificmarkerhindlimb stylopod muscle, skeletal muscle tissue of rectus abdominis, gastrocnemius
HFE-AS1

Protein interactions among cohort

Intra-cohort edges: 11.

Hub genes (top 10 by interactor count)

SymbolInteractor count
TF2,217
HAMP1,580
HFE1,569
SLC40A11,387
TFR21,077
HJV780
HFE-AS10

Intra-cohort edges

ABSources
HAMPHFEstring_interaction
HAMPHJVstring_interaction
HAMPSLC40A1string_interaction
HAMPTFR2string_interaction
HFEHJVstring_interaction
HFESLC40A1string_interaction
HFETFR2string_interaction
HJVSLC40A1string_interaction
HJVTFR2string_interaction
SLC40A1TFR2string_interaction
TFTFR2biogrid_interaction

Structural data

PDB: 5 · AlphaFold-only: 1 · No structure: 1

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
TFP0278766
SLC40A1Q9NP598
HAMPP811726
HFEQ302012
HJVQ6ZVN82

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
TFR2Q9UP5283.98

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 18. Enrichment computed across 7 evidence-associated genes (5 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 5 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Transferrin endocytosis and recycling3221.0×2e-06HFE, TF, TFR2
Iron uptake and transport3207.6×2e-06SLC40A1, TF, TFR2
Defective SLC40A1 causes hemochromatosis 4 (HFE4) (macrophages)11142.0×0.003SLC40A1
Defective CP causes aceruloplasminemia (ACERULOP)11142.0×0.003SLC40A1
Defective SLC40A1 causes hemochromatosis 4 (HFE4) (duodenum)11142.0×0.003SLC40A1
Metal ion SLC transporters1120.2×0.025SLC40A1
Netrin-1 signaling187.8×0.029HJV
Transport of small molecules210.1×0.033SLC40A1, TFR2
SLC transporter disorders140.8×0.049SLC40A1
R-HSA-425366136.2×0.049SLC40A1
Disorders of transmembrane transporters127.9×0.058SLC40A1
Cargo recognition for clathrin-mediated endocytosis120.9×0.064TF
Post-translational protein phosphorylation120.0×0.064TF
Platelet degranulation117.6×0.064TF
Regulation of Insulin-like Growth Factor (IGF) transport and uptake by Insulin-like Growth Factor Binding Proteins (IGFBPs)117.3×0.064TF
Clathrin-mediated endocytosis117.0×0.064TF
SLC-mediated transmembrane transport111.8×0.087SLC40A1
Disease12.6×0.328SLC40A1

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 6 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
multicellular organismal-level iron ion homeostasis6581.1×8e-16HFE, SLC40A1, TF, TFR2, HAMP, HJV
intracellular iron ion homeostasis6244.2×1e-13HFE, SLC40A1, TF, TFR2, HAMP, HJV
cellular response to iron ion31203.7×2e-08HFE, TF, TFR2
response to iron ion3468.1×3e-07HFE, TFR2, HAMP
transferrin transport2510.7×5e-05HFE, TFR2
positive regulation of peptide hormone secretion2510.7×5e-05HFE, TFR2
iron ion transport2295.6×1e-04TF, TFR2
positive regulation of receptor-mediated endocytosis2267.5×1e-04HFE, TF
negative regulation of iron ion transmembrane transport12808.7×0.001HAMP
spleen trabecula formation12808.7×0.001SLC40A1
endocytic iron import into cell12808.7×0.001TFR2
positive regulation of protein maturation12808.7×0.001TFR2
iron ion export across plasma membrane12808.7×0.001SLC40A1
negative regulation of iron export across plasma membrane12808.7×0.001HAMP
negative regulation of antigen processing and presentation of endogenous peptide antigen via MHC class I12808.7×0.001HFE
negative regulation of intestinal absorption12808.7×0.001HAMP
receptor-mediated endocytosis273.9×0.001HFE, TFR2
positive regulation of proteasomal ubiquitin-dependent protein catabolic process270.2×0.001TF, HAMP
BMP signaling pathway266.9×0.001HFE, HJV
regulation of iron ion transport11404.3×0.002HFE
response to iron ion starvation1936.2×0.003HFE
negative regulation of CD8-positive, alpha-beta T cell activation1702.2×0.003HFE
negative regulation of T cell cytokine production1401.2×0.006HFE
iron ion transmembrane transport1401.2×0.006SLC40A1
transcription by RNA polymerase II223.5×0.006SLC40A1, HJV
lymphocyte homeostasis1312.1×0.007SLC40A1
regulation of protein localization to cell surface1280.9×0.007HFE
cell surface receptor signaling pathway221.4×0.007HFE, TF
urate metabolic process1255.3×0.007HFE
hormone biosynthetic process1234.1×0.008HFE

Therapeutics

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 0 · Phased (≥1): 1 · Undrugged: 6

Druggability breadth: 4 of 7 evidence-associated genes (57%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
SLC40A111
HFE00
TF00
TFR200
HAMP00
HJV00
HFE-AS100

Drugs targeting cohort genes (top 30)

MoleculeMax phaseTargets in cohort
VAMIFEPORT HYDROCHLORIDE1SLC40A1

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
TF22Binding:13, Functional:9
SLC40A114Binding:14
HAMP9Binding:9

Pharmacogenomics

Cohort genes with a PharmGKB record: 6; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

1 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

CompoundMax phaseCohort target (bioactivity)
VAMIFEPORT HYDROCHLORIDE1SLC40A1

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved1SLC40A1
CDruggable family + PDB, no drug1HFE
DDruggable family + AlphaFold only, no drug1TFR2
EDifficult family or no structure, no drug4TF, HAMP, HJV, HFE-AS1

Undrugged target profiles

6 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
TFR20SLC40A1
HAMP9SLC40A1
HFE0
TF22
HJV0
HFE-AS10

Clinical trials & evidence

Clinical trials

Clinical trials: 24.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified16
PHASE24
PHASE33
PHASE11

Top trials by phase / activity

NCTPhaseStatusTitle
NCT00122980PHASE3TERMINATEDStroke With Transfusions Changing to Hydroxyurea
NCT00202436PHASE3COMPLETEDHaemochromatosis:Phlebotomy Versus Erythrocytapheresis Therapy
NCT00350662PHASE3COMPLETEDStudy With Deferiprone and/or Desferrioxamine in Iron Overloaded Patients
NCT00007150PHASE2ACTIVE_NOT_RECRUITINGTreatment of Hemochromatosis
NCT00000595PHASE2COMPLETEDEvaluation of Subcutaneous Desferrioxamine as Treatment for Transfusional Hemochromatosis
NCT00349453PHASE2COMPLETEDStudy Using Deferiprone Alone or in Combination With Desferrioxamine in Iron Overloaded Transfusion-dependent Patients
NCT01892644PHASE2WITHDRAWNTreatment of Iron Overload With Deferasirox (Exjade) in Hereditary Hemochromatosis and Myelodysplastic Syndrome
NCT00712738PHASE1COMPLETEDOral Nifedipine to Treat Iron Overload
NCT00001203Not specifiedCOMPLETEDDeferoxamine for the Treatment of Hemochromatosis
NCT00001455Not specifiedCOMPLETEDIron Overload in African Americans
NCT00005541Not specifiedCOMPLETEDHemochromatosis and Iron Overload Screening Study (HEIRS)
NCT00005559Not specifiedCOMPLETEDStatistical Basis for Hemochromatosis Screening
NCT00006312Not specifiedCOMPLETEDHemochromatosis–Genetic Prevalence and Penetrance
NCT00199628Not specifiedCOMPLETEDResearch Network for Neonatal Diseases Induced by Tissular Fetomaternal Alloimmunization
NCT00509652Not specifiedUNKNOWNErythrocyte Apheresis Versus Phlebotomy in Hemochromatosis
NCT00587535Not specifiedCOMPLETEDEvaluation of a New MR Pulse Sequence to Quantify Liver Iron Concentration
NCT01524757Not specifiedUNKNOWNProton Pump Inhibitors in the Prevention of Iron Reaccumulation in Patient With Hereditary Hemochromatosis
NCT01810965Not specifiedCOMPLETEDImpact of Bloodletting on Iron Metabolism in Type 1 Hemochromatosis
NCT02025543Not specifiedCOMPLETEDConfounder-Corrected Quantitative MRI Biomarker of Hepatic Iron Content
NCT02099214Not specifiedCOMPLETEDEstimation of Myocardial Iron Overload by 3 Tesla MRI in HFE Hereditary Haemochromatosis
NCT03654794Not specifiedCOMPLETEDStudy of the Cellular Diffusion of Tacrolimus Across the Membrane of Mononuclear Cells
NCT03743272Not specifiedCOMPLETEDRepeatability and Reproducibility of Multiparametric MRI
NCT04631718Not specifiedCOMPLETEDMRI QSM Imaging for Iron Overload
NCT06137079Not specifiedUNKNOWNIron Overload and Endocrinological Diseases

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
DEFEROXAMINE43
DEFERIPRONE42
DEFERASIROX41
HYDROXYUREA41
NIFEDIPINE41
CHEMBL463523401